Harmonizing work with the treatment and prevention of sleep disordered breathing in commercial motor vehicle drivers: implications for health and productivity management

[Sleep-disordered breathing in occupational places: from screening to Health and Productivity Management]

BACKGROUND

Sleep-disordered breathing (SDB), represented by sleep apnea, is highly prevalent in the general population and is associated with alcohol intake and obesity. Since SDB is further associated with hypertension, diabetes, and future cardiovascular diseases, as well as accidents and injuries in workplaces, there is a need for complete SDB assessment in workers, including screening and the application of diagnostic and therapeutic approaches.

RESULTS

Currently, it appears that SDB assessment is not sufficiently conducted, even among commercial motor vehicle (CMV) drivers, despite CMV drivers with SDB being at a high risk of serious traffic accidents. Based on a discussion conducted in The Study Group for Sleep Disordered Breathing in Work Places, we summarized the current situation in Japan and tried to elucidate the bottleneck of these approaches. Then, the situation in Japan was compared with that in South Korea; Professor Chol Shin substantiated that the situation in South Korea was similar to that in Japan. However, recently published data on CMV drivers in the United States showed that appropriate treatment of SDB reduced the risk of traffic accidents among CMV drivers. This will encourage the implementation of the required processes, from screening to maintenance of treatment.

CONCLUSION

We propose a new approach based on "harmonizing work with treatment and prevention" and "Health and Productivity Management (HPM)" as a solution for implementing SDB programs.

Toward the harmonization of work with treatment and prevention for patients with chronic respiratory failure

Home oxygen therapy (HOT), also known as long-term oxygen therapy, is prescribed to patients with chronic respiratory failure (CRF) due to advanced respiratory diseases, as it has been shown to improve the prognosis of patients with chronic obstructive pulmonary disease (COPD). However, the therapeutic impact of HOT does not fully reflect the "socialization" of patients, which is one of the final goals of "comprehensive pulmonary rehabilitation", proposed by the Japanese Respiratory Society. Since working is one form of socialization, we evaluated a 55-yr-old worker prescribed with HOT for the management of advanced COPD to elucidate and assess the social barriers experienced by HOT users. This case demonstrates a variety of factors affecting patients, respiratory physicians, occupational physicians, and management teams, which prevents patients from working. By elucidating these factors and seeking solutions, the promotion of the "harmonization of work with treatment and prevention" will both improve working environments and encourage CRF patients to continue working, leading to better socialization. Thus, the "harmonization of working with treatment and prevention" for CRF patients is a core goal for the promotion of both "health and productivity management" and "comprehensive pulmonary rehabilitation."